Abstract
ObjectiveThe objective of this retrospective, observational study was to estimate the long-term impact of early treatment of multiple sclerosis (MS) on the risk of disability pension.MethodsOur cohort comprised patients with MS in Sweden, identified in a nationwide disease-specific register (the Swedish Multiple Sclerosis Registry), who started treatment with a disease-modifying drug (DMD) between January 1, 2002, and December 31, 2012. We analyzed the association between time from onset of MS to treatment initiation and full-time disability pension using survival analysis.ResultsOur sample comprised 2477 patients. Unadjusted Kaplan–Meier failure functions showed that patients who started treatment within six months after onset had a lower risk of disability pension across follow-up compared with patients initiating therapy after 12 months. Outcomes from the univariate Cox proportional hazards model showed that time from onset to treatment initiation (in years) was significantly associated with disability pension (HR 1.03, p < 0.001). Outcomes from the multivariable Cox proportional hazards model showed that patients who started treatment within 6 months after onset had, on average, a 36% lower risk (HR 0.74, p = 0.010) of full-time disability pension during follow-up compared with patients starting treatment after 18 months when controlling for age, sex, marital status, university education, and prevalent comorbidities.ConclusionsWe show that early treatment with DMDs of MS is associated with a significantly reduced risk of disability pension. Our findings highlight the potential long-term benefits of early treatment of MS and should be helpful to inform ongoing discussion on the optimum medical management of the disease.
Highlights
In recent years, an extensive body of literature has accumulated with respect to benefits of early treatment of multiple sclerosis (MS) with disease modifying drugs (DMDs)
Patients who started treatment within 6 months after onset were estimated to have, on average, a 36% lower risk of permanently leaving the labor force to receive full-time disability pension compared with a patient starting treatment after 18 months when adjusting for age, sex, marital status, university education, and the prevalence of comorbidities
Our analyses show that early treatment with DMDs, as measured from onset of disease, was associated with a lower risk of full-time disability pension
Summary
An extensive body of literature has accumulated with respect to benefits of early treatment of multiple sclerosis (MS) with disease modifying drugs (DMDs). Research has shown that early treatment in relation to disease onset is associated with significantly improved physical and mental outcomes, including lower relapse rates and lower Expanded Disability Status Scale (EDSS) scores, both in the short- and long-term [1,2,3,4,5,6,7,8]. In accordance with these findings, in several jurisdictions, including the UK [9] and Sweden [10], clinical consensus is that DMDs should be offered as early as possible in the medical management of MS.
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